While panic can set in as we see the pounds add on during menopause, we can often neglect the foundational basics. There are many interwoven factors that can be creating an environment where your body wants to protect its' fat stores and add more. We walk you through these in other blogs. The aim of this is to be a primer for supporting some foundational things to promote healthy weight.
Decrease Alcohol Intake. Alcohol use among women has increased in the past few years. Women are experiencing alcohol related illness and death at unprecedented rates. In 2017, 77% of women reported consuming alcohol, up from 73% in 2015. Furthermore, alcohol is a source of calories without much nutritional value. It also may stimulate hunger, which can lead to overeating if you are not truly hungry and poor food selection. Not everything we eat has to be nutritious, but it goes without saying: if your nightly routine involves a glass or more of alcohol, this may be causing you to gain weight. Aim to cut your consumption progressively from a quarter to a half. Trying to cut it out completely at first may backfire, but cutting down even a little can be beneficial in multiple ways such as bone health and cardiovascular health. Canadian safe drinking guidelines suggest that alcohol consumption has a continuum of risk associated with the risk of harm. Not consuming alcohol has better benefits of health and sleep. Fewer than 2 drinks per week means you are less likely to avoid alcohol-related consequences for yourself. And no, you can’t “bank” drinks in anticipation of a weekend binge. If you have that feeling you just need a drink to relax or blow off steam, recognize this and start to replace it with a healthier behavior like going for a walk or calling a friend for a laugh.
Different Dietary Habits: As our lives change, so do our eating habits. We’re all busy! Many of us are caring for aging parents as well as our kids while trying to building our empires. So, what does that have to do with our diet? A lot. You may have less time to restock your fridge and pantry, less time to cook, and may skip meals, leading to rebound overeating. You may be eating in restaurants more often, which can also lead to
overeating and weight gain. Here are some quick take aways for healthier time-strapped eating choices:
Protein: In perimenopause, your body muscle mass begins to naturally decline. Ensuring you are consuming sufficient protein (approximately 20 grams per meal is a good ballpark to start, or 1.2-1.6 gm/kg, if you are active, you require more) can help maintain muscle, promote energy use, and make you feel full. Carry protein based snacks with you such as protein bars. (See our Protein Section)
Eating Styles: The diet industry has done a great job of keeping us on a “diet”. Don’t fall into this trap. However, there are some “eating styles” that have been shown to have positive results such as the Mediterranean style of eating (4,5). Intermittent Fasting has received a lot of attention, however, there is not sufficient evidence to support that fasting is effective in menopause (5). It is important to know that individuals may have different reactions and responses to certain eating styles.
Build a Routine: Meal prep, or even ingredient prep, are both excellent ways to get ahead of a less-healthy last-minute meal choice. Having food ready to go in your kitchen can be an incentive to eat at home versus stopping for takeout or ordering in. Schedule grocery shops, or get groceries delivered. Consider healthy meal delivery programs, and make your lunch for work, rather than going out every day. You’ll save money, too. Create a routine around this where you set aside time to prepare. Include the family and delegate. You don’t have to do it all yourself!!!
Bring Back the Family Meal and SLOW Down: Check-in, have you gotten into the habit where eating is a timed activity? Slow it down. Start your meal with a glass of water and taste your food! Bring back conversation to the dinner table.
Move More: Along with busyness impacting our eating habits, it can also affect how we move. Sitting at a desk or in a car all day, and just being too busy and tired to move our bodies can significantly affect our weight. Physical exercise is associated with lower body mass post menopause (6, 7). Not surprisingly, longer amounts of time sitting is correlated with higher body mass (7). We know that women are less active as they age when examining pre and post menopause women’s physical activity. It can feel daunting if you are not active to begin with, to start exercising in menopause, but starting with a mindset of how critical it is for your longevity might help with prioritizing it.
NEAT: Non-Exercise Activity Thermogenesis: is the part of our metabolism that comes from activities of daily living. This is movement that’s outside of intentional exercise, and actually burns more calories than intentional exercise. In other words, plan your day so you have to “move” just to do your errands and activities. Optimizing your NEAT is one of the best ways to help lose weight and keep it off, while also having a positive impact on physical and mental health. Walking instead of driving, housework, standing while you’re on the phone, parking further away from your destination, taking the stairs instead of elevator (YES!), make a meeting a phone call and walk during it, even fidgeting, are all ways to increase your NEAT.
Strength Training: Aim to work in at least 150–300 min a week of moderate-intensity, or 75-150 min a week of vigorous-intensity aerobic activity AND muscle-strengthening activities on 2 or more days a week (8). If you love walking, consider adding a weighted-vest to your walks to increase the stress on your body.
Prioritize Sleep Hygiene: How are you sleeping? It can be maddening to be told that we need to “get more sleep,” because for some of us, perimenopause and menopause can mess up our sleep with insomnia, hot flashes, and night sweats. It’s not as simple as just sleeping more! There is evidence to support women get less sleep in postmenopause compared to premenopause. However, not getting enough sleep can increase your appetite and intake, lower your activity level, and cause you to make different food choices that may not be the most physically nourishing. Sleep deprivation influences the hormones leptin and ghrelin, which are the signals that tells our brain when we are hungry or full.
If you’re having issues sleeping, do not be surprised! This is part of the perimenopause experience: trouble falling asleep, staying asleep, restless, you name it.
Sleep Hygiene Tips: Putting screens away at least an hour before bedtime, not consuming large meals, alcohol, or caffeine before bed, and sleeping in a dark, cool room can help. Stay tuned, we will be tackling sleep deeper!
Hormone Therapy: If you believe your sleep issues stem from hormonal shifts, speak to your doctor. Hormone replacement therapy can help.
Tart Cherry Juice: With menopause, there is a steady decline in melatonin. We all know melatonin as the magic that helps us sleep. Tart cherry juice contains tryptophan and melatonin, which can help regulate sleep. A glass of sugar-free tart cherry juice approximately one hour before bed could improve sleep quality. Tart cherry juice or supplements can also provide anti-inflammatory aspects that help promote sleep as well. Check if you are on medications as it can impact some of these such as blood pressure and diabetes medications.
Check out our resources on sleep
Medical Treatments. There are medical treatments, namely hormone therapy that support health in menopause. While we all want to take a pill versus change our behavior patterns (although remembering to take a pill daily can be a struggle!), healthy behaviors are not just important for our weight but our overall health and wellness. Do not fall victim to the on-line offers of herbal pills that will erase your belly fat. These will not work!
Hormone Therapy: Estrogen and progestin therapy has been shown to reduce weight around the waist and overall body mass index however, more research is required (7).
Weight Medications: Ozempic medications are now mainstream. This is a viable option for many women with health issues. When taking medications, there are important lifestyle modifications to offset risks such as muscle loss. Long term research on the health implications is needed.
While gaining weight and having weight around your belly is difficult. You are an amazing woman and not a function of the physical. It is a time to explore your relationship with your body and what your priorities are for life as you age. Do know, it is possible to maintain a healthy weight and even lose weight during menopause. For example, the Women’s Health Initiative (WHI) dietary modification trial has shown that women were able to lose and then maintain that lower weight over the menopause transition following group or individual sessions promoting a reduction in fat intake as well as an increase in fruit, vegetable, and grain consumption (7). We are all smart women and likely know must of what we ‘should do’ to be healthy, then why are we not all doing it? Because lifestyle behavior change is hard. A Dietitian and lifestyle liaison can help you sort through your path to healthy nutrition. Join PAUZ and we can connect you with services and supports, you are not alone!
Tips:
Spend time considering your relationship with food and how you view your body (see our article on “Rethinking Your Relationship with Food”). Your body is the vessel to take you through the rest of your life. How healthy you are entering into perimenopause has a major impact on your vitality and ability to “Take Life by the Ovaries”.
All behavior improvements and modifications are hard! Set small goals that you can sustain and gradually add to them. Find a buddy to commit to the same goal or join a group for a new physical activity you want to try.
Reducing fat (if your body fat/ adipose tissue is high) prior to menopause may help with visceral (waist) fat. Consider having a DEXA scan which can tell you what your fat levels are for the types of fat cells (visceral or adipose). This can serve as a baseline for you to work towards improving if needed.
Examine your nutrition, activity, and sleep patterns and explore their potential contribution to weight changes you may experience.
If you are in perimenopause or menopause, consider hormone therapy to support your overall health.
References:
Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010 Jan;11(1):11-8. doi: 10.1111/j.1467-789X.2009.00623.x. Epub 2009 Jul 28. PMID: 19656312.
Zamboni M, Armellini F, Milani MP, De Marchi M, Todesco T, Robbi R, Bergamo-Andreis IA, Bosello O. Body fat distribution in pre- and post-menopausal women: metabolic and anthropometric variables and their inter-relationships. Int J Obes Relat Metab Disord. 1992 Jul;16(7):495-504. PMID: 1323546.
Garaulet M, Pérez-Llamas F, Baraza JC, Garcia-Prieto MD, Fardy PS, Tébar FJ, Zamora S. Body fat distribution in pre-and post-menopausal women: metabolic and anthropometric variables. J Nutr Health Aging. 2002;6(2):123-6. PMID: 12166365.
Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008 Jun;32(6):949-58. doi: 10.1038/ijo.2008.25. Epub 2008 Mar 11. PMID: 18332882; PMCID: PMC2748330.
Howard BV, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B, et al. Low-fat dietary pattern and weight change over 7 years: The Women’s Health Initiative Dietary Modification Trial. JAMA 2006;295:39-49.
Additional Reads:
Pugliese G, Barrea L, Laudisio D, Aprano S, Castelluci B, Framondo L, et al. Mediterranean diet as tool to manage obesity in menopause: A narrative review. Nutrition 2020;79-80:110991
Kapoor E, Collazo-Clavell ML, Faubion SS. Weight gain in women at midlife: A concise review of the pathophysiology and strategies for management. Mayo Clin Proc 2017;92:1552-8.
Kanaley JA, Sames C, Swisher L, Swick AG, Ploutz-Snyder LL, Steppan CM, Sagendorf KS, Feiglin D, Jaynes EB, Meyer RA, Weinstock RS. Abdominal fat distribution in pre- and postmenopausal women: The impact of physical activity, age, and menopausal status. Metabolism. 2001 Aug;50(8):976-82. doi: 10.1053/meta.2001.24931. PMID: 11474488.
Bendinelli B, Pastore E, Fontana M, Ermini I, Assedi M, Facchini L, Querci A, Caini S, Masala G. A Priori Dietary Patterns, Physical Activity Level, and Body Composition in Postmenopausal Women: A Cross-Sectional Study. Int J Environ Res Public Health. 2022 May 31;19(11):6747. doi: 10.3390/ijerph19116747. PMID: 35682328; PMCID: PMC9180259.
Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009;41:459-
Fenton A. Weight, Shape, and Body Composition Changes at Menopause. J Midlife Health. 2021 Jul-Sep;12(3):187-192. doi: 10.4103/jmh.jmh_123_21. Epub 2021 Oct 16. PMID: 34759699; PMCID: PMC8569454.